HAMILTON — The Lakota West community suffered a sudden loss last week with the death of 15-year-old Matthew Stratman, who collapsed during a lacrosse game on June 9.
His family hopes the incident can raise awareness for a condition that in part caused his death: arteriovenous malformation.
An arteriovenous malformation, or AVM, is a tangle of blood vessels in the brain that causes internal bleeding and hemorrhaging. One in 700 people are diagnosed with an AVM each year, according to Dr. Mark Magner, a physician at Christ Hospital. With an AVM, blood rushing through arteries fails to slow down through capillaries and instead forms a web.
“You have extremely high pressure arteries that are built to be under high pressure going into veins which are not as strong as arteries because they’re only built to have a low-pressure scenario,” Magner said. “When that happens, veins form snakelike … little mushrooms of blood vessel walls, and those can be prone to leaking.”
AVMs have a small risk — only 2 percent — rupture each year. The mortality rate of patients who are diagnosed with AVMs is 10 percent.
The cause of AVMs remains fairly unknown. Dr. Charles Prestigiacomo, a professor of neurosurgery at University of Cincinnati’s College of Medicine, said AVMs are congenital and thought to be developed in utero, although they have not been proven to be hereditary.
“We’ve been trying to sort this out for a while,” Prestigiacomo said. “Nothing has ever been formally proven.”
An AVM is often a silent killer, Manger said. Most people with the condition are unaware they even have one prior to it rupturing. If the AVM develops in an area of the brain that does not control motor functions, any warning signs such as seizures or muscle weakness might not be present.
“The problem is that people don’t know that they have an AVM, unfortunately, until it declares itself, i.e., it bleeds,” Prestigiacomo said.
In Stratman’s case, he might not have shown any symptoms of hemorrhaging until the AVM ruptured.
A “thunderclap” headache is usually the first sign of a ruptured AVM. A patient might then fall into a seizure and present similar symptoms of a stroke. However, not all AVMs rupture. In many cases, they are found by coincidence through MRI or CAT scans.
In those cases, treatment of an AVM varies in a case-by-case basis. One option is surgery. Doctors could perform a craniectomy, in which a portion of the skull is removed to relieve the pressure of the swollen AVM on the brain. Or, if the AVM is in an operable portion of the brain, it could be dissected and removed. Surgeons use noodle-sized catheters to inject glue into the vessels to keep them from bleeding out.
Radiation treatments are also possible. Beams focused on the AVM can scar the enlarged blood vessels and eventually cause them to close. About 85 percent of the time, small AVMs can be cured with radiation, Prestigiacomo said.
The best treatment for a larger AVM, Magner and Prestigiacomo agreed, is a multidisciplinary approach of monitoring the condition, surgery or radiation, which varies largely on each patient.
“I don’t think there is a blanket statement that can be made,” Prestigiacomo said. “It’s a complex issue.”
In lieu of flowers, the Stratman family asked for memorial donations to the AVM Research Foundation, an organization committed to increase awareness and earlier detection of those affected.